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http://www.nase.org For more information, visit: www.nase.org/LearningCenter/BusinessTopics/Health The Affordable Care Act in Brief Impact on America’s Smallest Businesses A keystone of the ACA is the requirement that new health mar- ketplaces, known as an Exchanges, be set up in every state to offer health coverage options to individuals, families and small businesses to meet this new health coverage requirement. Enrollment in the newly created state-based Exchanges begins October 1, 2013. Due to their business structure, size and revenue, the self-employed will be markedly impacted by health reform. What Will Change For e Self-Employed? Insurance Market Reforms e self-employed can no longer be denied health coverage due to their health status. • Self-employed will have access to health insurance regard- less of pre-existing conditions or health status. • Self-employed with insurance will see improvements to their existing health coverage. • Self-employed with insurance purchased after September 23, 2010 will have access to expansive preventative services and health screenings. PRO: Increased access to health care for the self-employed. CON: Reforms will add to cost of health coverage. Essential Benefits Requirements e ACA created new minimum coverage guidelines for health insurance. • Health plans offered both in and out of Exchanges are required to offer a comprehensive package of benefits and services. • e self-employed will be able to choose between four levels of coverage: platinum, gold, silver and bronze. • Out-of-pocket costs and deductible limits would be restricted. • Insurance options will still vary by state since state determines what plans will meet new minimum coverage requirements. PRO: Provides the self-employed with quality, comprehensive plan options. CON: With new minimum coverage, higher health care costs for the self-employed. Exchanges New health marketplaces created in every state to allow indi- viduals, families and small businesses to shop and purchase health insurance via an online portal. • Must be set up by October 1, 2013 in each state. • Exchanges will also determine eligibility and direct quali- fying individuals into government programs like Medicaid, CHIP, etc. • States can set up their own Exchange, partner with the fed- eral government or opt out of setting up their Exchange. • Consumers in states that have opted out will access the Federal Exchange. PRO: Exchanges could create effective insurance pool to im- prove access and affordability of coverage while also making shopping for health coverage easier. CON: Dependent upon design and the role of state officials, could lead to minimal plan options and participation which would negatively impact cost of coverage. Premium Assistance e law provides for health insurance subsidies to be provided to individuals, including the self-employed, beginning in 2014. Self-employed business owners are not eligible for the Small Business Health Tax Credit. • Subsidies are only available to those who meet certain eligibil- ity requirements and purchase insurance in the new Exchanges. • Premium assistance credits available to individuals and families with income up to 400% of the federal poverty level. Adminis- tered as tax credits through the IRS. • e amount of the subsidy is dependent upon income level and the cost of premiums as a percentage of income. PRO: Provides financial support to afford health insurance, including the self-employed who have gone uninsured due to the high cost of coverage . CON: Assistance unavailable to those with current coverage un- less they drop and enroll in the new Exchange in their state. Beginning January 14, 2014, all Americans, including America’s smallest businesses – the self-employed – will be required to obtain health coverage or pay a penalty. Representing the most significant change to our health care system in decades, the Patient Protection and Affordable Care Act (ACA) was signed by President Barack Obama in March of 2010. • No longer can the self-employed be denied health coverage due to their health status: Insurance Market Reforms in ACA • Plans currently favored by the self-employed - catastrophic or major medical health plans- will be extinct in 2014. e self-employed will have new, more comprehensive insurance options: Essential Benefits Requirements in ACA • How the self-employed will access and shop for health coverage will change in 2014: State-based Exchanges in ACA • e ability of the self-employed to afford new health coverage options will be determined in 2014: Premium Assistance in ACA
